Customer Satisfaction Survey

Contact Name: (required)
Contact Title:
Company Name: (required)
Phone:
Fax:
Email: (required)
Address:
City:
State:
Zip Code: (required)
Country:
 

Order Information

* (only fill out if you have a specific issue)
Customer P.O. #:
Invoice #/Shipper #:

Product Information

* (only fill out if you have a specific issue)
Description:
Part #:
RMA #:
 

Comments

Comments:
 

Please take the time to assist our company with our commitment to Continual Improvement by answering the short survey below. On a scale of 1-10, check the number reflecting the degree of satisfaction. On a scale of 1-10, check the number reflecting the degree of satisfaction; check "n/a" if you don't know sufficiently to rate


Overall, how satisfied are you with the service(s) you received?

Very DissatisfiedVery Satisfied
 

How would you rate the Quality of the product(s) you received?

PoorExcellent
 

How courteous, attentive, and Technically Knowledgeable was/were the staff member(s) who provided the services(s)?

Not at allVery
 

Were the materials delivered on-time?

Definitely NotAbsolutely
 

How satisfied or dissatisfied are you with the price of the items you purchased based on the relative value of our product, as well as the service and support?

Not SatisfiedMost Satisfied
 

*please only hit the SUBMIT button once

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